I had HELLP (daughter now 24). My next pregnancy ended with fetal death at 20 weeks (at the time-- no known cause) Then I was infertile for many years. Almost nine years after HELLP I had a successful pregnancy (daughter now 15)

Here is what I have learned: Symptoms of HELLP can be caused by masked Vitamin B12 deficiency. We take prenatal vitamins with high folic acid (synthetic folate) but little or no active B12. Folic acid corrects the enlarged red blood cells doctors were taught to look for in B12 deficiency. If you are taking acid suppressing medicines, as many with HELLP do, you cannot digest B12 from food (acid is needed to extract B12 bound to animal protein.) But your growing baby needs increasing amounts of B12. By the third trimester the baby has high needs for B12 --for brain and bone growth-- right when the mother's stores may be severely depleted. Women with opposite extremes of B vitamin status -- high folic acid and low B12 -- are predisposed to high homocysteine. The B vitamins must work in synergy to keep homocysteine down.

Homocysteine is a toxic metabolite that builds up when your B vitamin metabolism is askew. Homocysteine is positively associated with developing preeclampsia and HELLP. So-called HELLP wasn't even a named syndrome until after high folic acid was added to prenatal vitamins. We all think folic acid is the same as real folate from food. In fact it is a synthetic unknown to the human body until the 1940s. Research in the 1940s showed us that people low in B12 should never have folic-acid-only interventions that can mask their B12 deficiency. In my case I have a common MTHFR gene variant that makes folic acid an inferior source of folate for me. Taking folic acid can actually lead to functional folate deficiency in some vulnerable people. In my case I was also eating less meat (the only food sources of B12 are animal products), taking Tums, and this was a second pregnancy, after a first pregnancy with severe unexplained anemia treated with folic acid and iron (no B12) I survived HELLP and DIC with 7 blood transfusions. No one ever tested my B12 or homocysteine, despite my being at one of the best teaching hospitals in America.

This is from NIH Rare Diseases Information website:Can the symptoms of HELLP syndrome be caused by a vitamin B12 deficiency?Although vitamin B12 deficiency is not typically included in the differential diagnosis for HELLP syndrome, there are overlapping features for both conditions. We identified the following reports of suspected HELLP syndrome that were due to deficiency of Vitamin B12.

http://www.ncbi.nlm.nih.gov/pubmed/23399716"The incidence of gestational hypertension and preeclampsia was 9.7% and 2.5% for women who took folic acid, and 9.4% and 2.4% for women who did not use it. The adjusted risk ratio associated with folic acid use was 1.08 (95% confidence interval, 1.04-1.11) for gestational hypertension and 1.11 (95% confidence interval, 1.04-1.18) for preeclampsia."

So if folic acid is supposed to be antagonizing B12 and causing PE/HELLP, it's responsible for .11 of the risk above 5%, which is to say one patient in every 200 patients, I think. Although the confidence interval is pretty big for me to say that so precisely.

http://www.ncbi.nlm.nih.gov/pubmed/21040211"Homocysteine levels in both maternal and fetal serum were significantly higher in the severe pre-eclampsia group compared to mild pre-eclampsia and control groups. However, homocysteine levels in both maternal and fetal serum were not significantly different between mild pre-eclampsia and control groups. No significant differences were observed in folic acid and vitamin B12 levels in both maternal and fetal serum between the groups."

So, there are no significant differences between the populations when it comes to serum levels of these vitamins.

More interesting, though, I think is the question of why the placenta might be altering these homocysteine levels in the severe patients! We know that the initial implantation of these placentas is altered in very early pregnancy and that one of the primary jobs of the placenta is to change maternal metabolism to support pregnancy. Does affecting B12 levels when placental implantation is severely compromised do something to allow the placenta to sustain pregnancy? Or is it just a spandrel?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PEDD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

I had HELLP at 36/6 with my first, who was born 2/15/12. I delivered a healthy baby boy six days ago on 4/4/14 at 39/1 with no HELLP at all! I was scared the entire pregnancy, but I am so thankful for a wonderful doctor and my own diligence in watching myself. It was totally worth it.

Hi, I had HELLP with my first baby at 36 weeks. Thankfully my son was born healthy via c-section, but was a little peanut under 5 lbs. I had been having high bp but not diagnosed with pre-e before I started having symptoms of HELLP. Well, I actually believe the signs of pre-e were there but I missed them. I did have instances where I'd see spots, especially in stores where light was very bright, but I didn't think much of it until afterwards. I had high bp but was not spilling protein in my urine, a class sign of pre-e. It wasn't until I had upper abdominal pain that I decided I needed medical attention, and had my son that same day.

I then went on 2 years later to deliver a health baby girl without experiencing HELLP again. I was referred to a high risk fetal/maternal specialist who followed me closely throughout my pregnancy. When my bp started creeping up they put me on a daily baby aspirin and bp medication. I had weekly non-stress tests during the last month or so of my 3rd trimester, and had a scheduled C-section.

What scares me now is the after effects of HELLP syndrome. Mine was a fairly mild case, I didn't end up in the ICU and my bp returned to normal in the weeks following delivery. But my dad recently had a stroke, and I know I'm at higher risk for developing heart disease and stroke after having HELLP. Plus, I think about my daughter someday having children and hope she doesn't have to go through what I did. I'm not sure if there's a genetic component or not. There is no history in my family of pre-e or HELLP.

Jacob - Born via c-section at 36 weeks due to HELLP syndromeSarah - Born at 39 weeks, hypertensive during pregnancy but no HELLP!

Hi. I am a type 1 diabetic. I was booked to be induced before due date as baby was getting quite big, but this is usual with type 1 diabetic pregnancies. During pregnancy sugar levels and blood pressure fine. Sailed through with no problems at all. Having healthy pregnancy. Until the day the abdominal pains hit. I got to the stage I couldn't breath and I was being sick i hubby's car on way to hospital. When I got to hospital my blood pressure was through the roof. Ended up having emergency C section, although they'd got my under control and in a better condition the baby was loosing oxygen. She ended up in special baby unit for a week before I was able to hold her. She was in a cooling suit to prevent brain damage. It worked! She was also 4 weeks early. She's now a healthy 2 1/2 year old. I'm now getting very broody and just too worried to risk it all again. My husband is against the idea. I suppose because he could have lost us both that night. I'd like advice, with the diabetes I have, would it be wise to have another baby?